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BRIAN HOWARD CLARK PT
>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1114063245
Individual Registrant: BRIAN HOWARD CLARK PT
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
1300 S MONTGOMERY AVE SHEFFIELD, AL 35660-6334 US
Tel: 256-386-4005 Fax: 256-386-4685
Tel: 256-386-4005 Fax: 256-386-4685
Contact information for business:
2101 VIRGINIA AVE MUSCLE SHOALS, AL 35661-2633 US
Tel: 256-314-0491 Fax: 256-386-4067
Tel: 256-314-0491 Fax: 256-386-4067
Registration Information:
NPI: 1114063245
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist | AL | PTH3211 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BLUE CROSS | 51513137 | AL | 01 |
